HBV携带产妇的血清及乳汁HBV-DNA载量的差异与母乳喂养安全性的研究(英文)

Load of HBV DNA in serum and breast milk of HBV carried mother and safety of breast-fed infants

目的探讨HBV携带产妇的血清、乳汁中HBV-DNA不同载量与实施母乳喂养安全性的关系及对母婴传播阻断效果的影响。方法应用荧光定量聚合酶链反应和酶免疫测定(EIA)技术对91例HBsAg、HBeAg双阳性产妇血清、乳汁及婴儿24月龄血标本进行HBV-DNA定量和HBVM检测。32例婴儿采用母乳喂养,59例采用人工喂养。对两种喂养方式的婴儿做3(T3)、9(T9)、12(T12)、24(T24)个月追踪检测观察。结果HBsAg、HBeAg双阳性产妇的血清、乳汁中HBV-DNA阳性率为100%、49.45%(P<0.005),HBV-DNA平均含量(拷贝数/毫升的对数,x±s)为(7.43±1.81)、(4.02±1.01);初乳HBV-DNA的检出率随母血HBV-DNA载量的增加而增加,两者呈正相关。母乳和人工两种方式喂养的婴儿HBV感染率为15.63%和13.56%,统计学处理χ2=0.022,P>0.05差异无显著性;母乳喂养组抗体几何平均滴度(GMT)明显高于人工喂养组;发生HBV-DNA感染的13例婴儿T24血标本HBV-DNA载量为(3.24±0.23)。结论HBsAg、HBeAg双阳性产妇血清HBV-DNA载量大于109cps/mL的婴儿是母婴传播的高危易感人群。HBV感染的婴儿HBV-DNA水平较低,病毒载量<104cps/mL。乳汁HBV-DNA阳性率和病毒载量明显低于血清,HBV携带产妇的婴儿接受正规乙肝基因工程疫苗(HBice)全程免疫或HBice和HBIG(乙肝免疫球蛋白)的主、被动联合免疫后,母乳喂养不影响母婴传播阻断效果,母乳喂养有助于提高婴儿抗-HBs的GMT水平。

[Objective] To investigate the relationship between the load of HBV-DNA in serum and breast milk of pregnant women carrying HBV and the safety of breast-feeding and to explore the blocking effect on the mother-infant transmission of HBV. [Methods] Content of HBV-DNA and/or HBVM in serum and breast milk specimens of 91 pregnant women with positive HBsAg and HBeAg and in serum specimens of their 24 month old infants were detected by Real-time quantitative polymerase chain reaction（ RQ-PCR ） and/or EIA at the age of 3rd（T3）, 9th（Tg）, 12th（T12）, 24th（T24） month old. 32 infants were received by breast-feeding, 59 infants were received by bottle-feeding. [Results] HBV-DNA positive rates in the blood and breast milk of pregnant women were 100% and 49.45%, respectively （P 〈0.005）. Their average concentrations of HBV-DNA were （7.43±1.81） and （4.02±1.01）, respectively. The HBV-DNA level in serum of the pregnant women was correlated to the oufletting rate of HBV-DNA in colostrum positively. The infective rates of HBV in the two group infants were 15.63% and 13.56%,respectively. There was no significant difference （χ^2 =0.022, P 〉0.05）. The GMT of anti-HBs in breat fed group infants were higher than those of artifical fed group infants. [Conclusion] When the load of HBV-DNA in serum specimen of pregnants women with positive HBsAg and HBeAg was more than 109 copies/ml, their newborns were as a high risky population of HBV vertical transmission. Load of HBV-DNA in serum was less than 104 copies/ml in infants infected by HBV. The positive rate and the content of HBV-DNA in colostrum were less than those in serum obviously. After newborns of HBV positive mothers received the combined immunization of HBvac and HBIG, the breast feeding did not influence the blocking effect on mother-infant transmission of HBV and helped increasing the GMT of anti-HBs in blood of infants.